Dermatologic Manifestations of Reactive Arthritis Medication
- Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD more...
Medication Summary
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Antibiotics
Class Summary
Antibiotics may be used to treat antibacterial and anti-inflammatory effects, as well for possible coexistent infection.
Minocycline (Dynacin, Minocin)
Used to treat infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma organisms. Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
Doxycycline (Vibramycin, Doryx, Bio-Tab)
Used to treat infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma organisms. Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
Azithromycin (Zithromax)
Used to treat mild-to-moderate microbial infections.
Cefdinir (Omnicef)
Third-generation cephalosporin indicated for the treatment of susceptible infections.
Vitamins
Class Summary
These agents are essential for normal DNA synthesis and metabolism of proteins, carbohydrates, and fats.
Calcipotriene (Dovonex)
Synthetic vitamin D-3 analog that regulates skin-cell production and development. Use 0.005% cream, ointment, or solution.
Nonsteroidal anti-inflammatory drugs
Class Summary
These agents have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may include inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.
Indomethacin (Indocin)
Potent inhibitor of cyclo-oxygenase, which may decrease the local production of arachidonic acid–derived chemotactic factors for eosinophils present in sebum.
Antineoplastic agents
Class Summary
These agents have antiproliferative and immunosuppressive effects.
Azathioprine (Imuran)
May be used alone or as a steroid-sparing agent. Antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. May decrease proliferation of immune cells, which results in lower autoimmune activity. Used more commonly for reactive arthritis and psoriasis. Thiopurine methyltransferase levels should be checked prior to the use of azathioprine.
Methotrexate (Folex PFS, Rheumatrex)
Indicated for the symptomatic control of severe, recalcitrant, disabling psoriasis, and severe reactive arthritis. Also used alone or in combination with other anticancer agents in the treatment of advanced mycosis fungoides and cancer of the head, neck, or lung, particularly those of the squamous cell and small cell types.
Antimalarials
Class Summary
Derivatives of 4-aminoquinoline are active against a variety of autoimmune disorders. Use with caution because hydroxychloroquine has a known risk of exacerbating psoriasis. These agents should probably be used only in conjunction with rheumatologic evaluation because it is used for the arthritis and not the skin involvement.
Hydroxychloroquine (Plaquenil)
Inhibits chemotaxis of eosinophils, locomotion of neutrophils, and impairs complement-dependent antigen-antibody reactions. Hydroxychloroquine sulfate 200 mg is equivalent to 155 mg hydroxychloroquine base and 250 mg chloroquine phosphate
Retinoids
Class Summary
Retinoids decrease the cohesiveness of abnormal hyperproliferative keratinocytes and may reduce the potential for malignant degeneration. They also modulate keratinocyte differentiation.
Isotretinoin (Accutane)
Oral agent used to treat serious dermatologic conditions. Synthetic 13-cis isomer of the naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A. Alters pattern of keratinization, reduces bacterial flora, and has an anti-inflammatory effect.
A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.
Acitretin (Soriatane)
Retinoic acid analog, similar to etretinate and isotretinoin. Etretinate is the main metabolite and has clinical effects similar to those of etretinate. Its mechanism of action is unknown.
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